Provider Demographics
NPI:1477679470
Name:GRUNDSET, KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:GRUNDSET
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9899 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-3010
Mailing Address - Country:US
Mailing Address - Phone:727-813-8168
Mailing Address - Fax:727-258-4804
Practice Address - Street 1:9634 107TH AVE N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-4503
Practice Address - Country:US
Practice Address - Phone:813-816-8006
Practice Address - Fax:727-258-4804
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice